Alkoholbedingte Störungen - Ätiopathogenese und therapeutischer Ausblick

Zusammenfassung

In den letzten Jahren konnten wichtige Fortschritte bei der Erforschung der neurobiologischen Grundlagen alkoholbedingter Störungen verzeichnet werden. Sehr gut untersucht sind die Auswirkungen von Alkohol auf die Neurotransmittersysteme. Eine dopaminerge und GABAerge Bahnung trägt maßgeblich zu den Stimulationseffekten geringer Dosen Ethanols bei, höhere Dosen vermitteln über eine glutamaterge Hemmung viele der negativen Wirkungen. Zahlreiche Ergebnisse belegen, dass ein verminderter Serotoninstoffwechsel einen Risikofaktor für die Entwicklung einer Alkoholabhängigkeit darstellt. In diesem Zusammenhang wird die Erfolgsgeschichte des Absinths diskutiert, ein Ethanol- und Thujon-haltiges Getränk, wobei Thujon eine GABAerge Hemmung und eine veränderte serotonerge Ansprechbarkeit bewirkt. Auch für die Bedeutung von Cannabinoid- sowie striataler Opiat-Rezeptoren bei Ethanolabhängigkeit sprechen zahlreiche Ergebnisse. Bildgebungsuntersuchungen weisen eine wichtige Rolle des Belohnungssystems bei alkoholbedingten Störungen nach. Untersuchungsergebnisse belegen, dass genetische Faktoren prädisponierend wirken können und dass die Genexpression einer Steuerung durch biologische und Umweltfaktoren unterliegt. Störungen der Hypothalamus-Hypophysen-Nebennierenrinden-Achse sind ebenfalls bei Alkoholabhängigkeit nachweisbar. Das Verständnis der neurobiologischen Zusammenhänge alkoholbedingter Störungen wird sicher dazu beitragen, deren Therapieoptionen zu erweitern und zu verbessern.

Abstract

The scientific understanding of the neurobiological priniciples of alcoholism has made significant progress in recent years. Especially the effects of ethanol on the neurotransmitter-systems are well studied. Dopaminergic and GABAergic facilitation contribute to the stimulating effects of low doses of alcohol while many of its adverse effects are mediated by glutamatergic inhibition at higher doses. A reduced serotonine-metabolism was shown to be a risk factor for the development of an alcohol dependence. The historic success of absinthe is discussed in this context. Absinthe is a mixture of ethanol and thujone, a substance that leads to a GABAergic inhibition as well as a reduced serotonergic responsiveness. Many studies substantiate the role of cannabinoid as well as striatal opiate-receptors in alcohol-related disorders. Neuroimaging studies could prove the important role of the reward system in this connection. Genetic factors were shown to be predisposing, however biological and environmental factors have a regulatory effect on the gene expression. Disturbances of the hpa-axis (hypothalamus-pituitary gland-adrenal cortex) were also shown to play a role in alcohol dependence. The understanding of these neurobiological principles of alcohol-related disorders should contribute to enhance and improve their therapeutic options.

Schlüsselwörter

Ethanol - Alkoholmissbrauch - Alkoholabhängigkeit - Neurotransmitter - Genetik - neuroendokrine Peptide - Absinth

Key words

ethanol - alcohol abuse - alcohol dependence - neurotransmitters - genetics - neuroendocrine peptides - absinthe

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